Gavrysyuk V, Merenkova E, Gumeniuk G, Gumeniuk M, Dziublyk Y
State Institution "National Institute of Phthisiology and Pulmonology them. F. G. Yanovsky NAMS of Ukraine ", Kiev, Ukraine.
Georgian Med News. 2018 Oct(283):34-38.
Immunosuppressants are traditionally administered in sarcoidosis patients with contraindications for the use of glucocorticosteroids (GCS), or in those with serious adverse reactions on GCS, as well as in the cases of GCS-therapy resistance. Aim - to study the effectiveness and safety of methotrexate monotherapy in pulmonary sarcoidosis patients with either GCS contraindication or adverse reactions. We examined 33 patients with st. II pulmonary sarcoidosis, 20 men and 13 women, 23-67 years of age. In all cases a general physical examination; chest computed tomography and spirometry were performed. Oral methotrexate 10 mg once per week was administered to all patients. Blood tests, including total blood count with platelet count, blood chemistry (ALT, AST, bilirubin, creatinin) were done before the start of the therapy and monthly afterwards. Methotrexate monotherapy appeared to be effective in 24 (72,7%) study patients (clinical cure or regression of lung lesions). Adverse reactions were registered in 10 (30,3%) patients. In 1 case treatment was stopped because of the serious adverse event. As it was confirmed by our study results, methotrexate should be considered a medication of choice in pulmonary sarcoidosis patients with contraindications for use or adverse reactions to GCS. A research of combination therapy of methotrexate with first-line drugs should be continued.
传统上，免疫抑制剂用于患有糖皮质激素（GCS）使用禁忌症的结节病患者、对GCS有严重不良反应的患者以及GCS治疗耐药的患者。目的——研究甲氨蝶呤单药治疗对有GCS禁忌症或不良反应的肺结节病患者的有效性和安全性。我们检查了33例II期肺结节病患者，其中男性20例，女性13例，年龄在23至67岁之间。所有患者均进行了全身检查、胸部计算机断层扫描和肺活量测定。所有患者均口服甲氨蝶呤，每周一次，每次10毫克。在治疗开始前及之后每月进行血液检查，包括全血细胞计数及血小板计数、血液生化检查（谷丙转氨酶、谷草转氨酶、胆红素、肌酐）。甲氨蝶呤单药治疗在24例（72.7%）研究患者中显示有效（临床治愈或肺部病变消退）。10例（30.3%）患者出现不良反应。1例因严重不良事件停止治疗。根据我们的研究结果证实，甲氨蝶呤应被视为有GCS使用禁忌症或不良反应的肺结节病患者的首选药物。应继续研究甲氨蝶呤与一线药物的联合治疗。
